![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 38. Go back in thread:
Posted by RobertDavid on March 15, 2006, at 21:48:53
In reply to Re: Taking the Parnate plunge today... » JaclinHyde, posted by Phillipa on March 15, 2006, at 20:46:01
Good luck, looking forward to hearing how you do. I'll be giving my first try with an MAOI soon too......
Posted by Rocket Jackson on March 16, 2006, at 8:57:58
In reply to Re: Taking the Parnate plunge today..., posted by RobertDavid on March 15, 2006, at 21:48:53
> Good luck, looking forward to hearing how you do. I'll be giving my first try with an MAOI soon too......
Great! Best of luck with your upcoming trial as well. Which MAOI will you most likely be using? What condition(s) will you be treating? I hope it works out well for you. I'll continue to keep you updated with my results.
RJ
Posted by Rocket Jackson on March 16, 2006, at 9:10:26
In reply to Taking the Parnate plunge today..., posted by Rocket Jackson on March 15, 2006, at 14:47:38
As expected, no changes. I took my three 10mg doses yesterday and my morning dose this morning. My goal is to stick to a 6am, 2pm, and 10pm regimen to make it easier to remember to take them as well as have nice even spacing (maybe a little OCD there as well :)). It works out well with my work schedule anyway.
I do maybe notice a very slight increase in energy this morning, but it is very slight (could also be my diet dew, though I drink this every morning so have quite a nice tolerance built up and typically don't feel much from it). I certainly doubt it's elevated BP from the caffeine in the pop. I'm trying not to over-interpret anything I might feel, but it's probably always difficult to stay un-biased. But certainly no major changes.
Take care all. Have a great day!
RJ
Posted by TylerJ on March 16, 2006, at 10:30:28
In reply to Parnate day #2, posted by Rocket Jackson on March 16, 2006, at 9:10:26
> As expected, no changes. I took my three 10mg doses yesterday and my morning dose this morning. My goal is to stick to a 6am, 2pm, and 10pm regimen to make it easier to remember to take them as well as have nice even spacing (maybe a little OCD there as well :)). It works out well with my work schedule anyway.
>
> I do maybe notice a very slight increase in energy this morning, but it is very slight (could also be my diet dew, though I drink this every morning so have quite a nice tolerance built up and typically don't feel much from it). I certainly doubt it's elevated BP from the caffeine in the pop. I'm trying not to over-interpret anything I might feel, but it's probably always difficult to stay un-biased. But certainly no major changes.
>
> Take care all. Have a great day!
>
> RJIt might take a wk or two, or rarely 6 wks to get a good response. Mine came on the 10th day. You won't mistake it as Mountain dew...it's much better than caffiene. :) If you are anything like me you'll be saying... "Why didn't I try this a long time ago!" My biggest concern is your dose schedule. Parnate is very activating, so I take mine all in the morning and it works great all day long. Taking it at 10pm may cause terrible insomnia. My suggestion is, take most or all in morning and the rest around 12-2p.m., but no later. But most importantly is take it as your Doc wants you to. I wish you all the Luck in the World! :)
Tyler
Posted by gardenergirl on March 16, 2006, at 14:44:49
In reply to Parnate day #2, posted by Rocket Jackson on March 16, 2006, at 9:10:26
> As expected, no changes. I took my three 10mg doses yesterday and my morning dose this morning. My goal is to stick to a 6am, 2pm, and 10pm regimen to make it easier to remember to take them as well as have nice even spacing (maybe a little OCD there as well :)). It works out well with my work schedule anyway.
That's pretty much how I take my Nardil. It also works out well with my vitamin supplements, as far as keeping them separate from Synthroid.
Good luck with your trial. I hope it does the trick!
gg
>
Posted by Rocket Jackson on March 17, 2006, at 8:59:13
In reply to Taking the Parnate plunge today..., posted by Rocket Jackson on March 15, 2006, at 14:47:38
Good morning,
I'll spare you all my daily "no changes" posts during these initial days until the hopeful POW kicks in around week 1 or 2 or so. :) Even if this doesn't occur, I'll add to my parnate "diary" a few times per week or as changes happen. Needless to say, here on day #3, I don't feel much, but I'm optimistic for the next few weeks!
Have a great weekend!
RJ
Posted by Rocket Jackson on March 17, 2006, at 14:28:23
In reply to Re: Parnate day #2, posted by TylerJ on March 16, 2006, at 10:30:28
> > As expected, no changes. I took my three 10mg doses yesterday and my morning dose this morning. My goal is to stick to a 6am, 2pm, and 10pm regimen to make it easier to remember to take them as well as have nice even spacing (maybe a little OCD there as well :)). It works out well with my work schedule anyway.
> >
> > I do maybe notice a very slight increase in energy this morning, but it is very slight (could also be my diet dew, though I drink this every morning so have quite a nice tolerance built up and typically don't feel much from it). I certainly doubt it's elevated BP from the caffeine in the pop. I'm trying not to over-interpret anything I might feel, but it's probably always difficult to stay un-biased. But certainly no major changes.
> >
> > Take care all. Have a great day!
> >
> > RJ
>
> It might take a wk or two, or rarely 6 wks to get a good response. Mine came on the 10th day. You won't mistake it as Mountain dew...it's much better than caffiene. :) If you are anything like me you'll be saying... "Why didn't I try this a long time ago!" My biggest concern is your dose schedule. Parnate is very activating, so I take mine all in the morning and it works great all day long. Taking it at 10pm may cause terrible insomnia. My suggestion is, take most or all in morning and the rest around 12-2p.m., but no later. But most importantly is take it as your Doc wants you to. I wish you all the Luck in the World! :)
>
> Tyler
>Hi Tyler,
Thanks for your always helpful and supportive posts. I've been thinking about your problem with parnate insomnia and have considered adjusting my dosing regimen to avoid it. I ran it by my doc in the beginning (whose overall knowledge I sometimes question, to be honest), and he insisted that he has all his patients take doses at bedtime and they have no difficulty with sleeping. But judging from your experience and those from others on this forum and various other sites, it seems it indeed is a common side effect. Did you notice the insomnia right off the bat, or did not take effect until the medication kicked in? I'm wondering if I should hold off on changing my regimen until possible insomnia, or go ahead and take preemptive action. I'm definitely sleeping well now, but it's only day 3.
Also, just out of curiosity, do you personally feel the full effect of the parnate essentially all day, or are there periodic peaks and valleys? Do you get to the point where you reach a kind of "steady state" where you feel that effect pretty much all the time?
Thanks again for your help. Keep on enjoying that parnate power!!
RJ
Posted by Rocket Jackson on March 20, 2006, at 8:55:12
Hello,
Still nothing on day 6 of parnate, but there's still plenty of potential time in the "range" of when people typically begin responding. However, I am beginning to wonder if my dose is a bit low for social anxiety. I've read in past posts that the 60-80mg/day range is the norm... any opinions on this? I'm still on 10mg three times per day, and am trying to decide if I should wait out this dose a bit longer or go ahead and bump it up a bit. It's always nice to stay as low as possible of course, but if people with social phobia typically don't respond at 30mg/day (I know we all differ, but it's often telling if MOST people need a higher dosage), then I may go up. Just curious what you all thought.
Thanks!
RJ
Posted by TylerJ on March 20, 2006, at 10:35:05
In reply to Parnate day #6... dosage?, posted by Rocket Jackson on March 20, 2006, at 8:55:12
> Hello,
>
> Still nothing on day 6 of parnate, but there's still plenty of potential time in the "range" of when people typically begin responding. However, I am beginning to wonder if my dose is a bit low for social anxiety. I've read in past posts that the 60-80mg/day range is the norm... any opinions on this? I'm still on 10mg three times per day, and am trying to decide if I should wait out this dose a bit longer or go ahead and bump it up a bit. It's always nice to stay as low as possible of course, but if people with social phobia typically don't respond at 30mg/day (I know we all differ, but it's often telling if MOST people need a higher dosage), then I may go up. Just curious what you all thought.
>
> Thanks!
>
> RJHey Rocket,
I can't write much, my computor is on the blink.:( I would ask your Doc first, but I would say it's time to bump it up to 40 or 50mgs a day now. Pls. be patient, i didn't feel anything until I got to 60. Best wishes!Tyler
Posted by TylerJ on March 20, 2006, at 15:53:27
In reply to Re: Parnate day #2 » TylerJ, posted by Rocket Jackson on March 17, 2006, at 14:28:23
> > > As expected, no changes. I took my three 10mg doses yesterday and my morning dose this morning. My goal is to stick to a 6am, 2pm, and 10pm regimen to make it easier to remember to take them as well as have nice even spacing (maybe a little OCD there as well :)). It works out well with my work schedule anyway.
> > >
> > > I do maybe notice a very slight increase in energy this morning, but it is very slight (could also be my diet dew, though I drink this every morning so have quite a nice tolerance built up and typically don't feel much from it). I certainly doubt it's elevated BP from the caffeine in the pop. I'm trying not to over-interpret anything I might feel, but it's probably always difficult to stay un-biased. But certainly no major changes.
> > >
> > > Take care all. Have a great day!
> > >
> > > RJ
> >
> > It might take a wk or two, or rarely 6 wks to get a good response. Mine came on the 10th day. You won't mistake it as Mountain dew...it's much better than caffiene. :) If you are anything like me you'll be saying... "Why didn't I try this a long time ago!" My biggest concern is your dose schedule. Parnate is very activating, so I take mine all in the morning and it works great all day long. Taking it at 10pm may cause terrible insomnia. My suggestion is, take most or all in morning and the rest around 12-2p.m., but no later. But most importantly is take it as your Doc wants you to. I wish you all the Luck in the World! :)
> >
> > Tyler
> >
>
> Hi Tyler,
>
> Thanks for your always helpful and supportive posts. I've been thinking about your problem with parnate insomnia and have considered adjusting my dosing regimen to avoid it. I ran it by my doc in the beginning (whose overall knowledge I sometimes question, to be honest), and he insisted that he has all his patients take doses at bedtime and they have no difficulty with sleeping. But judging from your experience and those from others on this forum and various other sites, it seems it indeed is a common side effect. Did you notice the insomnia right off the bat, or did not take effect until the medication kicked in? I'm wondering if I should hold off on changing my regimen until possible insomnia, or go ahead and take preemptive action. I'm definitely sleeping well now, but it's only day 3.
>
> Also, just out of curiosity, do you personally feel the full effect of the parnate essentially all day, or are there periodic peaks and valleys? Do you get to the point where you reach a kind of "steady state" where you feel that effect pretty much all the time?
>
> Thanks again for your help. Keep on enjoying that parnate power!!
>
> RJHi Rocket,
Sorry it took so long to get back to you, I'm having comp. probs.
I've never heard of a doc prescribing a dose of Parnate at bedtime, it's very stimulating-the last thing you need before sleep...Wow, that's really strange to me. I personally take my full dose first thing in the morning and it works great for me all day long..no highs no lows, just steady ad effect all day long. I'm even sleeping better now w/less Traz. Most people split Parn. thru out the day, but usually not after 2:00 because of the insomnia prob. For me all in the morning works best. :) I'm sorry I almost never go against what a doc says to do, but I would not take Parnate at bedtime, it just doesn't make good sense at all. I wish you the very best..let me know how you are doing.Tyler
Posted by djmmm on March 21, 2006, at 12:12:53
In reply to Parnate day #6... dosage?, posted by Rocket Jackson on March 20, 2006, at 8:55:12
> Hello,
>
> Still nothing on day 6 of parnate, but there's still plenty of potential time in the "range" of when people typically begin responding. However, I am beginning to wonder if my dose is a bit low for social anxiety. I've read in past posts that the 60-80mg/day range is the norm... any opinions on this? I'm still on 10mg three times per day, and am trying to decide if I should wait out this dose a bit longer or go ahead and bump it up a bit. It's always nice to stay as low as possible of course, but if people with social phobia typically don't respond at 30mg/day (I know we all differ, but it's often telling if MOST people need a higher dosage), then I may go up. Just curious what you all thought.
>
> Thanks!
>
> RJYour current schedule seems very conservative, to me. You could try taking 20mg as your initial dose, then 10mg in the afternoon. Call your Pdoc and ask if you can step up the dose/schedule. I found relief at 40mg for a long time, but recently have upped the dose, which is common.
Posted by Rocket Jackson on March 22, 2006, at 8:59:17
Good morning,
Well, I'm a little bummed to say I haven't noticed anything big on parnate yet, but I'm still holding out for the best. While I do feel like I have an overall better mood (particularly in the morning), I don't suffer from depression and haven't felt a major difference as far as the social anxiety goes. But I find that I'm debating myself as to whether I really AM feeling something, albeit just more subtley, as I don't have the same kind of fear I had before to actually leave my office at work. Definitely nothing pro-social, however, and I still feel pretty anxious in most social situations.
Since I've surpassed the one week point, I've gone ahead and raised my dose to 40mg/day (20mg at 6am, 10mg at 1pm, and 10mg at 7pm) to see if I might be a little sub-therapeutic. I found a post from back in '98 or '99 on this forum from Dr. Bob that suggested perhaps a lack of dreaming (from supressed REM) may indicated an appropriate dose of parnate. Has anyone else heard of or experienced this? I'm sure it's not a gold standard indicator but may be a possible effect among others.
Oddly enough, my sleep has been great since I moved my evening dose from 10pm to 7pm. I can fall asleep pretty easily around 10:30pm or so, sleep soundly all night, and wake up refreshed at 5:30-6am. I'm definitely pretty exhausted around late evening, however, which appears to be quite common from coming down off the quick amphetamine-like effect after dosing. I'm hoping this may surpass with time.
Anyway, just thought I'd post an update. I'll continue to do so periodically. Good luck to you all!
RJ
Posted by TylerJ on March 22, 2006, at 10:40:42
In reply to Parnate day #8 update, posted by Rocket Jackson on March 22, 2006, at 8:59:17
> Good morning,
>
> Well, I'm a little bummed to say I haven't noticed anything big on parnate yet, but I'm still holding out for the best. While I do feel like I have an overall better mood (particularly in the morning), I don't suffer from depression and haven't felt a major difference as far as the social anxiety goes. But I find that I'm debating myself as to whether I really AM feeling something, albeit just more subtley, as I don't have the same kind of fear I had before to actually leave my office at work. Definitely nothing pro-social, however, and I still feel pretty anxious in most social situations.
>
> Since I've surpassed the one week point, I've gone ahead and raised my dose to 40mg/day (20mg at 6am, 10mg at 1pm, and 10mg at 7pm) to see if I might be a little sub-therapeutic. I found a post from back in '98 or '99 on this forum from Dr. Bob that suggested perhaps a lack of dreaming (from supressed REM) may indicated an appropriate dose of parnate. Has anyone else heard of or experienced this? I'm sure it's not a gold standard indicator but may be a possible effect among others.
>
> Oddly enough, my sleep has been great since I moved my evening dose from 10pm to 7pm. I can fall asleep pretty easily around 10:30pm or so, sleep soundly all night, and wake up refreshed at 5:30-6am. I'm definitely pretty exhausted around late evening, however, which appears to be quite common from coming down off the quick amphetamine-like effect after dosing. I'm hoping this may surpass with time.
>
> Anyway, just thought I'd post an update. I'll continue to do so periodically. Good luck to you all!
>
> RJ
Sounds promising...and you're still way early in the game. The first day I felt anything was day Ten at 60 mgs. Try something for a few days, take 30 in morn. and 10-20 at noon, if this doesn't help try 40 or 50 all in morn. It's not going to hurt anything, and my guess is you'll be pleasently surprised! Keep up the good work. :)Tyler
Posted by Rocket Jackson on March 22, 2006, at 13:07:30
In reply to Re: Parnate day #8 update » Rocket Jackson, posted by TylerJ on March 22, 2006, at 10:40:42
> > Good morning,
> >
> > Well, I'm a little bummed to say I haven't noticed anything big on parnate yet, but I'm still holding out for the best. While I do feel like I have an overall better mood (particularly in the morning), I don't suffer from depression and haven't felt a major difference as far as the social anxiety goes. But I find that I'm debating myself as to whether I really AM feeling something, albeit just more subtley, as I don't have the same kind of fear I had before to actually leave my office at work. Definitely nothing pro-social, however, and I still feel pretty anxious in most social situations.
> >
> > Since I've surpassed the one week point, I've gone ahead and raised my dose to 40mg/day (20mg at 6am, 10mg at 1pm, and 10mg at 7pm) to see if I might be a little sub-therapeutic. I found a post from back in '98 or '99 on this forum from Dr. Bob that suggested perhaps a lack of dreaming (from supressed REM) may indicated an appropriate dose of parnate. Has anyone else heard of or experienced this? I'm sure it's not a gold standard indicator but may be a possible effect among others.
> >
> > Oddly enough, my sleep has been great since I moved my evening dose from 10pm to 7pm. I can fall asleep pretty easily around 10:30pm or so, sleep soundly all night, and wake up refreshed at 5:30-6am. I'm definitely pretty exhausted around late evening, however, which appears to be quite common from coming down off the quick amphetamine-like effect after dosing. I'm hoping this may surpass with time.
> >
> > Anyway, just thought I'd post an update. I'll continue to do so periodically. Good luck to you all!
> >
> > RJ
>
>
> Sounds promising...and you're still way early in the game. The first day I felt anything was day Ten at 60 mgs. Try something for a few days, take 30 in morn. and 10-20 at noon, if this doesn't help try 40 or 50 all in morn. It's not going to hurt anything, and my guess is you'll be pleasently surprised! Keep up the good work. :)
>
> TylerThanks, Tyler. I appreciate the advice. Your dosing recommendation sounds like a good one. Did you ever notice the "buzzy" feeling in the morning and then sort of a "crash" in the later afternoon? It's not terrible exhaustion, but sometimes is a bit limiting in terms of motivation to get things done.
And was it pretty much nothing until day 10 when you awoke with the full effect? That's amazing. I'm looking forward to that day. :) It definitely sounds the feeling you get when it works is unmistakable.
Thanks again for all your input. Take care!
RJ
Posted by JaclinHyde on March 22, 2006, at 13:54:26
In reply to Re: Parnate day #8 update » TylerJ, posted by Rocket Jackson on March 22, 2006, at 13:07:30
It IS unmistakable, I can vouch for that too. But because you are not depressed per se your reaction may be a bit more subtle. However I do remember that I suffered from extreme panic attacks that kept me housebound for the most part. When Nardil kicked in one morning I remember I just wanted to GET THE HELL OUT OF MY HOUSE, lol! You have little indicators of promise going on there. I agree that your dose may be too low though. The problem with many doctors is that they UNDER dose a lot of people. Just my .02, ymmv.
JH
Posted by JaclinHyde on March 22, 2006, at 13:57:11
In reply to Re: Parnate day #8 update, posted by JaclinHyde on March 22, 2006, at 13:54:26
Oh and you ARE early in the game. It took almost 7 weeks to have Nardil kick in. Parnate is quicker though but as far as how quick depends on each individual. And a big yes on the dream thing too. MAOI's surpress REM sleep so that is a good indicator that it is doing something in there ;-)
JH
Posted by tessellated on March 22, 2006, at 16:54:04
In reply to Re: Parnate day #8 update, posted by JaclinHyde on March 22, 2006, at 13:57:11
i not sure how long it takes for the MAOI for reduce MAO to 80%.
I having been on parnate 3 times already 12 days in am pushing 80-100 to feel alert, alive, humorous and sensitive..
i still don' t know why using stims for kids doesn't cause even worse psychosis
Posted by fires on March 22, 2006, at 18:22:21
In reply to Parnate day #8 update, posted by Rocket Jackson on March 22, 2006, at 8:59:17
>>Since I've surpassed the one week point, I've gone ahead and raised my dose to 40mg/day (20mg at 6am, 10mg at 1pm, and 10mg at 7pm) to see if I might be a little sub-therapeutic.<<
Wow, 40 mg at day 8! When I took it for Dep., it took almost 4 weeks until I got up to 40-60 mg. I would have been fainting right and left at 40 mg by day 8.
Good luck
Posted by TylerJ on March 22, 2006, at 18:43:05
In reply to Re: Parnate day #8 update » TylerJ, posted by Rocket Jackson on March 22, 2006, at 13:07:30
> > > Good morning,
> > >
> > > Well, I'm a little bummed to say I haven't noticed anything big on parnate yet, but I'm still holding out for the best. While I do feel like I have an overall better mood (particularly in the morning), I don't suffer from depression and haven't felt a major difference as far as the social anxiety goes. But I find that I'm debating myself as to whether I really AM feeling something, albeit just more subtley, as I don't have the same kind of fear I had before to actually leave my office at work. Definitely nothing pro-social, however, and I still feel pretty anxious in most social situations.
> > >
> > > Since I've surpassed the one week point, I've gone ahead and raised my dose to 40mg/day (20mg at 6am, 10mg at 1pm, and 10mg at 7pm) to see if I might be a little sub-therapeutic. I found a post from back in '98 or '99 on this forum from Dr. Bob that suggested perhaps a lack of dreaming (from supressed REM) may indicated an appropriate dose of parnate. Has anyone else heard of or experienced this? I'm sure it's not a gold standard indicator but may be a possible effect among others.
> > >
> > > Oddly enough, my sleep has been great since I moved my evening dose from 10pm to 7pm. I can fall asleep pretty easily around 10:30pm or so, sleep soundly all night, and wake up refreshed at 5:30-6am. I'm definitely pretty exhausted around late evening, however, which appears to be quite common from coming down off the quick amphetamine-like effect after dosing. I'm hoping this may surpass with time.
> > >
> > > Anyway, just thought I'd post an update. I'll continue to do so periodically. Good luck to you all!
> > >
> > > RJ
> >
> >
> > Sounds promising...and you're still way early in the game. The first day I felt anything was day Ten at 60 mgs. Try something for a few days, take 30 in morn. and 10-20 at noon, if this doesn't help try 40 or 50 all in morn. It's not going to hurt anything, and my guess is you'll be pleasently surprised! Keep up the good work. :)
> >
> > Tyler
>
> Thanks, Tyler. I appreciate the advice. Your dosing recommendation sounds like a good one. Did you ever notice the "buzzy" feeling in the morning and then sort of a "crash" in the later afternoon? It's not terrible exhaustion, but sometimes is a bit limiting in terms of motivation to get things done.
>
> And was it pretty much nothing until day 10 when you awoke with the full effect? That's amazing. I'm looking forward to that day. :) It definitely sounds the feeling you get when it works is unmistakable.
>
> Thanks again for all your input. Take care!
>
> RJ
>
>I did get the crash when I first began taking it, it disappeared after about 3 wks. I didn't just wake up feeling great on day 10, when I took my medicine that morning 60mgs. all at once about 45 mins later I felt a very nice lift, it's very comfortable, and feels stimulating but not wired. You'll definitely know what it is when it happens to you. It's not like w/ssri's and other AD's where you say " hmmm...I guess I'm feeling a little better," with Parnate you'll say..."Wow, I feel Great"! I still get that feeling now at almost 2 mos. and I can feel it working all day long! Suddenly, the anxiety was gone, I felt like doing things again, feel a lot more social...everything's better! I'm now at 120mgs. all in the morning...I'm hoping not to go any higher than this. It's gunna happen to you too...just be patient, keep increasing the dose a little every 3-4 days and my hope, my gut feeling is it will work for you just as it has for me and millions of others..stay in touch. :)
Tyler
Posted by TylerJ on March 22, 2006, at 19:05:10
In reply to Re: Parnate day #8 update, posted by JaclinHyde on March 22, 2006, at 13:57:11
> Oh and you ARE early in the game. It took almost 7 weeks to have Nardil kick in. Parnate is quicker though but as far as how quick depends on each individual. And a big yes on the dream thing too. MAOI's surpress REM sleep so that is a good indicator that it is doing something in there ;-)
>
> JH
JH,
I'm on 120 mgs now and still feeling great...however i'm not as "stimulated" as once was, but that's OK...I think I may have been real close to manic for a week or so. :) I'm sleeping much better w/traz at 200 and benadryl 50. I'm definitely dreaming a lot also...wonder if it's from the Traz?
You're still doing great? What dose are you on? Do you dream? Hope all is well.Tyler
Posted by jedi on March 22, 2006, at 23:03:50
In reply to Parnate day #8 update, posted by Rocket Jackson on March 22, 2006, at 8:59:17
Here is a pretty good review of the literature on social anxiety disorder.
JediEncephale. 2004 Jul-Aug;30(4):301-13.
[Neurobiology and pharmacotherapy of social phobia]
[Article in French]
Aouizerate B, Martin-Guehl C, Tignol J.
Service de Psychiatrie d'Adultes, (Professeur Tignol) Universite Victor-Segalen Bordeaux 2, Centre Hospitalier Charles-Perrens, Centre Carreire, 121, rue de la Bechade, 33076 Bordeaux.
Social phobia (also known as social anxiety disorder) is still not clearly understood. It was not established as an authentic psychiatric entity until the diagnostic nomenclature of the American Psychiatric Association DSM III in 1980. In recent years, increasing attention among researchers has contributed to provide important information about the genetic, familial and temperamental bases of social phobia and its neurochemical, neuroendocrinological and neuroanatomical substrates, which remain to be further investigated. Up to date, there have been several findings about the possible influence of variables, including particularly genetic, socio-familial and early temperamental (eg behavioral inhibition) factors that represent risk for the later development of social phobia. Clinical neurobiological studies, based on the use of exogenous compounds such as lactate, CO2, caffeine, epinephrine, flumazenil or cholecystokinin/pentagastrin to reproduce naturally occurring phobic anxiety, have shown that patients with social phobia appear to exhibit an intermediate sensitivity between patients with panic disorder and control subjects. No difference in the rate of panic attacks in response to lactate, low concentrations of CO2 (5%), epinephrine or flumazenil was observed between patients with social phobia and normal healthy subjects, both being less reactive compared to patients with panic disorder. However, patients with social phobia had similar anxiety reactions to high concentrations of CO2 (35%), caffeine or cholecystokinin/pentagastrin than those seen in patients with panic disorder, both being more intensive than in controls. Several lines of evidence suggest specific neurotransmitter system alterations in social phobia, especially with regard to the serotoninergic, noradrenergic and dopaminergic systems. Although no abnormality in platelet serotonin transporter density has been found, patients with social phobia appear to show an enhanced sensitivity of both post-synaptic 5HT1A and 5HT2 serotonin receptor subtypes, as reflected by increased anxiety and hormonal responses to serotoninergic probes. Platelet 5HT2 receptor density has also been reported to be positively correlated to symptom severity in patients with social phobia. During anticipation of public speaking, heart rate was elevated in patients with social phobia compared to controls. Norepinephrine response to the orthostatic challenge test or to the Valsalva maneuver was also greater in patients with social phobia. While normal beta-adrenergic receptor number was observed in lymphocytes, a blunted response of growth hormone to clonidine, an a2-adrenergic agonist, was reported. This suggests reduced post-synaptic a2-adrenergic receptor functioning related to norepinephrine overactivity in social phobia. Decreased cerebrospinal fluid levels of the dopamine metabolite homovanillic acid have also been observed. There are relatively few reports of involvement of the adrenal and thyroid functions in social phobia, and all that has been noted is that patients with social phobia show an exaggerated adrenocortical response to a psychological stressor. Recent advances in neuro-imaging have contributed to find low striatal dopamine D2 receptor binding or low dopamine transporter site density in patients with social phobia. They have also demonstrated the involvement of the cortico-limbic pathways, including the prefrontal cortex, hippocampus and amygdala, which show an increased activity in different experimental conditions. These brain regions have extensively been reported to play an important role in the cognitive appraisal in determining the significance of environmental stimuli, in the emotional and mnemonic integration of information, and in the expression of contextual fear-conditioned behaviors, which might be disrupted in the light of the phenomelogical aspects of social phobia. A substantial body of literature based on case reports, open and placebo-controlled trials, has now clearly examined the efficacy of major classes of psychotropic agents including monoamine oxidase inhibitors, beta-blockers, selective serotonin reuptake inhibitors and benzodiazepines in social phobia. Until recently, irreversible non-selective monoamine oxidase inhibitors, of which phenelzine was the most extensively evaluated, were considered as the most efficacious treatment in reducing the symptomatology associated with social phobia in 50-70% of cases after 4 to 6 weeks. However, side effects and dietary restrictions limit their use. This led to the development of reversible inhibitors of monoamine oxidase A, for which careful dietary monitoring is not required. Moclobemide has been the most widely studied but produced unconvincingly therapeutic effects on social phobic symptoms. To date, selective serotonin reuptake inhibitors may be considered as a reasonable first-line pharmacotherapy for social phobia. There is growing evidence for the efficacy of the selective serotonin reuptake inhibitors fluvoxamine, fluoxetine, citalopram, paroxetine and sertraline. They have beneficial effects with response rates ranging from 50 to 80% in social phobia. It has been recommended that the treatment period should be extended at least 6 months beyond the early improvement achieved within the first 4 to 6 weeks. The overall advantages include tolerability with a low risk of adverse events. The benzodiazepines clonazepam and alprazolam have also been proposed for the treatment of social phobia. Symptomatic relief occurred in 40 to 80% of the cases with a relatively rapid onset of action within the first two weeks. Untoward effects, discontinuation-related withdrawal symptoms and abuse or dependence liability constitute major concerns about the use of benzodiazepines, so they should be reserved for cases unresponsive to the safer medications cited above. Beta-blockers such as atenolol and propanolol have commonly been employed in performance anxiety, decreasing autonomic symptoms (eg, tachycardia, sweating and dry mouth). However, they are not effective in the generalized form of social phobia. Other pharmacologic alternatives seem helpful for the management of social phobia, including venlafaxine, gabapentin, bupropion, nefazodone or augmentation with buspirone. Preliminary studies point to promising effects of these agents. Larger controlled clinical trials are now needed to confirm their potential role in the treatment of social phobia.
Posted by JaclinHyde on March 23, 2006, at 0:29:02
In reply to Recent Social Anxiety Info » Rocket Jackson, posted by jedi on March 22, 2006, at 23:03:50
Great article, thanks for posting it Jedi :-)
JH
Posted by JaclinHyde on March 23, 2006, at 0:36:01
In reply to Re: Parnate day #8 update » JaclinHyde, posted by TylerJ on March 22, 2006, at 19:05:10
> JH,
> I'm on 120 mgs now and still feeling great...however i'm not as "stimulated" as once was, but that's OK...I think I may have been real close to manic for a week or so. :) I'm sleeping much better w/traz at 200 and benadryl 50. I'm definitely dreaming a lot also...wonder if it's from the Traz?
> You're still doing great? What dose are you on? Do you dream? Hope all is well.
>
> TylerYep, still doing fine :-) I agree with the mania thing (but ain't it fun?) but that has passed for the most part. I have pushed myself up to 100mg because 60 just doesn't cut it. No more black and blues either. I have become a tylenol junkie and refuse to take any nsaids or aspirin unless absolutely necessary. Dreaming? What's that? And yes, imho 200mg of Traz is going to make your dreams very vivid. I only take about 25mg every now and then when I want a switch from my usual ambien CR. The parnate counteracts the weird dreams I use to have on traz so I can finally fall asleep and know that I am not going to beat my husband up in the middle of the night. Unless he deserves it of course ;-) I am glad you are still doing great. See I told you you wouldn't need to augment!
Your Parnate Pal,
JH
Posted by Rocket Jackson on March 23, 2006, at 8:31:34
In reply to Recent Social Anxiety Info » Rocket Jackson, posted by jedi on March 22, 2006, at 23:03:50
Thanks Jedi. That's good stuff.
RJ
Posted by TylerJ on March 23, 2006, at 10:16:22
In reply to Re: Parnate day #8 updateTyler, posted by JaclinHyde on March 23, 2006, at 0:36:01
> > JH,
> > I'm on 120 mgs now and still feeling great...however i'm not as "stimulated" as once was, but that's OK...I think I may have been real close to manic for a week or so. :) I'm sleeping much better w/traz at 200 and benadryl 50. I'm definitely dreaming a lot also...wonder if it's from the Traz?
> > You're still doing great? What dose are you on? Do you dream? Hope all is well.
> >
> > Tyler
>
> Yep, still doing fine :-) I agree with the mania thing (but ain't it fun?) but that has passed for the most part. I have pushed myself up to 100mg because 60 just doesn't cut it. No more black and blues either. I have become a tylenol junkie and refuse to take any nsaids or aspirin unless absolutely necessary. Dreaming? What's that? And yes, imho 200mg of Traz is going to make your dreams very vivid. I only take about 25mg every now and then when I want a switch from my usual ambien CR. The parnate counteracts the weird dreams I use to have on traz so I can finally fall asleep and know that I am not going to beat my husband up in the middle of the night. Unless he deserves it of course ;-) I am glad you are still doing great. See I told you you wouldn't need to augment!
>
> Your Parnate Pal,
> JH
>
>Yea...the "mania phase" was nice, I still feel a definite power surge from it, just not a strong amphetamine effect anymore which I hear is normal for the Big P.
Hey, I forgot you had 25 successful yrs. w/nardil. Maybe you could 'coach' poor Tepi with his Nardil titration. He really worries me. He's just not getting the help he needs...and I wonder about his Doc???
Take care..and keep doing great with *Parnate Power*! :)Tyler
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